Can you lower yourself to the floor and stand back up without using your hands or knees for support? A landmark 25-year follow-up study has uncovered that the Floor Sit-Rise Test (SRT) serves as a surprisingly accurate predictor of premature death from natural causes and cardiovascular issues in middle-aged and older adults. The research reveals that difficulties in performing this basic movement—such as relying on hands to sit down, using knees to push up, or showing signs of instability—are telltale signs of reduced muscle strength, flexibility, and balance. These physical limitations are closely intertwined with heart health and overall life expectancy, offering a straightforward yet powerful tool to assess health risks without the need for complex medical equipment.
Main Content
We all understand the importance of regular exercise for maintaining good health, yet when it comes to actually getting active, countless excuses often stand in our way. "I’m too exhausted today," "The weather is far too unpleasant to go outside," "I’m not in the right mindset," or even "My body feels perfectly fine—I don’t really need to exercise." Have these rationalizations ever crossed your mind?
Recently, scientists have introduced a remarkably simple yet potentially game-changing "health assessment" method: the Floor Sit-Rise Test (SRT). Their findings suggest that individuals who rely on their hands while sitting down or use their knees for leverage when standing up—along with those who exhibit shaky movements—demonstrate insufficient physical agility, muscle power, and balance. These factors are deeply connected to cardiovascular health and can even influence the length of our lives.
DOI: 10.1093/eurjpc/zwaf325
Study Design
The data for this comprehensive study was drawn from the CLINIMEX Exercise Open Cohort Study, which spanned from July 1998 to December 2023. After a rigorous screening process, the research team enrolled 4,282 participants aged between 46 and 75 years old, with 67.5% being male. All participants had no significant physical or clinical limitations that would hinder their ability to perform standard fitness tests, and they were all participating in this type of assessment for the first time.
Graphical Abstract
The testing environment was carefully prepared: a 2×2-meter flat surface with a non-slip finish. Participants were instructed to remove their shoes and wear loose-fitting clothing to ensure unrestricted movement. The key instruction given was: "There’s no need to focus on speed. Just do your best to sit down on the floor and stand back up, using the minimal amount of support you think is necessary." Each action—sitting down and standing up—started with a base score of 5 points, with deductions applied for specific movements. Here’s a detailed breakdown:
- The test begins from a standing position: participants must slowly lower themselves to the floor and then return to a standing position.
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The maximum possible score for the entire test is 10 points (5 points for the sitting movement and 5 points for the standing movement).
Deduction Criteria:
- 1 point is deducted each time hands, knees, or forearms are used for support (as illustrated in the accompanying diagram).
- 0.5 points are deducted if the body shows obvious signs of shaking or instability.
- A score of 0 is given to participants who are completely unable to perform the movement independently.
Figure 1: Basic information of the floor sit-to-stand test and scores
Every 1-Point Drop in Score Correlates with a 30% Increase in Death Risk
Over a median follow-up period of 12.3 years (with an interquartile range of 7.6 to 18.0 years), 665 participants (accounting for 15.5% of the total) passed away due to natural causes. When the research team divided the participants into five groups based on their SRT scores, a clear pattern emerged: the mortality rate increased in direct proportion to the decrease in SRT scores.
Further analysis revealed that compared to participants who scored a perfect 10 points, those who scored between 0 and 4 points faced:
- 3.84 times higher risk of dying from natural causes
- 6.05 times higher risk of dying from cardiovascular-related causes
Figure 2: Kaplan-Meier survival curves of natural and cardiovascular mortality according to the sit-to-stand test scores in middle-aged and elderly subjects
What’s more, this correlation remained statistically significant even after adjusting for variables such as age, gender, body mass index (BMI), and pre-existing medical conditions like coronary heart disease, hypertension, dyslipidemia, and diabetes. The survival analysis painted an even clearer picture, showing stark differences in survival rates across different SRT score groups. The lower the SRT score, the lower the survival rate.
For instance, over a 10-year follow-up period, the survival rates were as follows: 97% for the 10-point group, 88% for the 8-point group, and a mere 73% for the 0–4-point group. Perhaps most striking is the fact that nearly half (49.5%) of the participants who were unable to stand up from the floor independently (scoring 0 points) died during the follow-up period, while only 4.4% of those who could stand up perfectly (scoring 5 points for the standing movement) passed away—representing an enormous 11-fold difference in risk.
Why Is This Simple Movement So Crucial?
The study points out that participants with low SRT scores commonly suffer from issues such as poor body composition (characterized by excessive body fat), weak muscle strength, limited flexibility, and inadequate balance. These physical limitations can lead to an increased risk of falls and injuries, which in turn can restrict daily activities and reduce opportunities for exercise. This creates a harmful cycle that negatively impacts survival rates. When it comes to cardiovascular death risk, problems like poor flexibility and weak muscle strength may be linked to vascular abnormalities, endothelial dysfunction, insulin resistance, and other metabolic disorders—all of which can contribute to an increased risk of cardiovascular diseases.
Figure 3: Kaplan-Meier survival curves of natural and cardiovascular mortality according to the sit-to-stand test scores in middle-aged and elderly subjects with a history of coronary artery disease
Perhaps one of the most significant findings of this study is that the SRT score was found to be closely correlated with natural mortality rates in both healthy individuals and those with pre-existing cardiovascular conditions such as coronary heart disease. This suggests that the predictive power of the SRT is widely applicable, making it a valuable tool for assessing health risks among middle-aged and older adults with varying health profiles.
Key Insights
In summary, the Floor Sit-Rise Test offers several notable advantages as a health assessment tool:
- Early Warning System: Muscle decline often occurs before the onset of cardiovascular symptoms, allowing for earlier intervention.
- Broad Applicability: The test is effective for both healthy individuals and those with a history of coronary heart disease.
- Targeted Exercise Recommendations: Individuals with low SRT scores can benefit from tailored exercise programs focused on enhancing lower-body muscle strength and improving balance.
Conclusion
What may seem like a simple sit-and-stand movement holds remarkable insights into our overall health and longevity. The Floor Sit-Rise Test is more than just a physical fitness assessment; it serves as a window into the body’s ability to maintain essential functions. Whether you’re looking to prevent chronic diseases or simply enhance your overall well-being, mastering this basic movement could be a crucial step toward a longer, healthier life. By understanding what your ability (or inability) to perform this movement indicates, you can take proactive steps to address any underlying health issues and make lifestyle changes that promote long-term vitality.
Reference
Araújo, C. G. S., de Souza e Silva, C. G., Myers, J., Laukkanen, J. A., Ramos, P. S., & Ricardo, D. R. (2025). Sitting–rising test scores predict natural and cardiovascular causes of deaths in middle-aged and older men and women. European Journal of Preventive Cardiology. DOI: 10.1093/eurjpc/zwaf325.